Document (1) (7)
Document (1) (7)
Name:
Age:
Gender:
Informed consent:
You are invited to participate in a research study. If you agree to participate, you will be
asked to complete a questionnaire that will take approximately 10 minutes. All
information you provide will be kept strictly confidential. Your identity will not be
revealed in any reports or publications resulting from this study. Data will be stored
securely and will only be accessible to the research team.
Instructions: Indicate the extent to which each item applies to you using the scale in
the five columns to the right of each item.
This scale is used to indicate the extent of your agreement with each statement.
Please select the number that best represents your response:
1 – Strongly Disagree
2 – Disagree
3 – Neither Disagree nor Agree
4 – Agree
5 – Strongly Agree
Please note that items 5, 28, and 33 feature a reverse scale (it’s not a mistake!), where
“Strongly disagree” = 5 and “Strongly agree” = 1.
4. I actively participate in
every discussion.
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